The WellBeing of the Paramedic

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The Well-Being of the Paramedic
I wish we had a one-man stretcher!
2
Wellness Components

• Physical well-being
• and
• Mental and emotional health
• The physical as well as mental emotional health
  are critical to the EMS providers health and
  safety in order to function during stressful times

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Physical Well-Being

• Several factors play a major role
  in maintaining physical health
• Good nutrition
• Physical fitness
• Adequate sleep
• Disease prevention
• Injury prevention

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Assessing Your Risk Factors

• Gives valuable insight into your personal
  well-being
• Assess for
• pertinent family history
• symptoms/conditions currently present
• daily levels of exercise activity/commitment
• diet body mass index
• lifestyle habits (smoking, stress, activity,
  addictions)

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Nutrition

• Nutrients
• Foods that contain elements necessary for body
  function
• Six categories
• Carbohydrates
• Fats
• Proteins
• Vitamins
• Minerals
• Water

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Carbohydrates

• Composed of carbon, hydrogen,
  and oxygen
• Primarily are obtained from
  plant foods
• Lactose (milk sugar) only important
• source of animal carbohydrate
• Plants store carbohydrates as starch
• Cooking makes starches easier to digest
• Generally healthy intake lt300 grams/day

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Fats Fatty Acids

• Fats in food are mixtures of three types of fatty
  acids
• ?Saturated fat - primarily found in meat dairy
• raises cholesterol levels should be avoided
• ?Polyunsaturated - found in safflower, sunflower,
  corn soybean, cottonseed oils some fish
• helps body rid self of newly formed cholesterol

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Fats Fatty Acids

• ?Monounsaturated fats - liquid vegetable oils
  such as canola and olive
• these may decrease cholesterol levels
• The 3 types of fats differ in chemical makeup and
  in the types of foods in which they appear
• Daily fat intake
• total fats limited to 65 grams/day
• saturated fats limited to 20 grams/day

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Cholesterol

• Present in all foods of animal origin
• Heavily concentrated in fat and in poultry skin
• White, waxy substance found in every cell
• Needed by the body for normal functioning
• Manufactured in liver and is
  carried through bloodstream
• High blood cholesterol levels
  increase risk of heart disease and
• stroke (healthy level is lt200 borderline
• high is 200-239 unhealthy is gt240)

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Cholesterol

• HDL (average normal men - 45 women - 55)
• good (healthy) cholesterol
• helps carry LDL away from arteries
• LDL (optimal level is lt100)
• bad cholesterol
• deposits on artery walls
• Triglycerides (normal is lt150)
• much of the bodys fat is stored in the form of
  triglycerides for later use as energy

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Proteins

• Composed of hydrogen, oxygen, carbon, and
  nitrogen
• Most also contain sulfur and phosphorus
• Essential to building body tissue during growth,
  maintenance, and repair
• When digested, breaks down into
  amino acids
• Classified as either essential
  or nonessential
• Daily intake adequate at
• 50 grams/day

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Amino Acids

• Essential amino acids
• Absolutely necessary for body growth and cellular
  life
• Must be obtained in food since they are not
  produced in body
• Nonessential amino acids
• Can be manufactured in the body

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Proteins/Amino Acids

• Proteins that contain all essential amino acids
  are complete proteins
• Meats and dairy products
• Proteins that are missing one or more essential
  amino acids are incomplete proteins
• Grains and vegetables
• Proteins can be used
  as
  a source of energy

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Vitamins

• Organic substances present in minute amounts in
  foods
• Must be obtained in food or through vitamin
  supplements
• Essential for metabolism
• Cannot be produced in adequate
  amounts by the body
• Vitamins classified as
• Water-soluble
• Fat-soluble

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Water-Soluble Vitamins

• Eight water-soluble vitamins in vitamin C and B
  complexes
• Water-soluble vitamins
  cannot be stored in the body
• Must be provided
  by daily diet

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Fat-Soluble Vitamins

• Vitamins A, D, E, and K
• Can be stored in the body
• Therefore, daily dietary intake of these vitamins
  not required

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Minerals

• Inorganic elements that play an essential role in
  biochemical reactions in the body
• Include calcium, chromium, iron, magnesium,
  potassium, selenium, sodium, and zinc
• Like vitamins, minerals
  are obtained through
  the diet

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Water

• Most important nutrient because cellular function
  depends on a fluid environment
• Composes 50 to 60 of total body weight
• Infants have the greatest percentage
  of body
  water older adults
  have the least
• Obtained through consumption
  of liquids and fresh fruits
  and
  vegetables
• Also is produced when food is
  oxidized during digestion
• Basic rule for consumption
• 21/2 - 31/2 liters of fluid/day

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Food Groups

• Food Pyramid- rough guideline periodic revisions
• 5major food groups
• Dairy products
• 2-3 servings/day
• Meat, fish, poultry
• 2-3 servings/day
• Vegetables
• 3-5 servings/day
• Fruits
• 2-4 servings/day
• Grains
• 6-11 servings /day

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Food Labels

• Check serving size listed to avoid
  misinterpreting information
• Reading labels helps consumer choose food wisely

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Principles of Weight Control

• Ideal weight controversial
• Should be used only as a guide
• People who are overweight tend
  to be at greater risk for developing
• High blood pressure
• Diabetes mellitus
• Heart disease
• Some cancers
• Other illnesses

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Ideal Body Weight

• Common measurement of obesity is based on Body
  Mass Index (BMI)
• BMI calculation
• divide your weight in pounds by height in inches
• divide that number again by height in inches
• multiply the answer in step 2 by 703
• BMI implications
• 18.5 - 25 ideal body weight
• 25 - 27 potential health risk
• over 30 significant health risk

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Principles of Weight Control

• Eat right balance of foods in moderation
• Limit fat consumption to no
  more than 65 grams of fat
  per day in a 2000
  calorie diet
• Exercise regularly
• generally acceptable is
• a workout three to
• four times per week for a minimum
• of 30 minutes per exercise day

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Principles of Weight Control

• Tips to change behavior
• Set realistic goals
• Make a commitment to change
• Keep to your exercise schedule
• Make healthier food choices
• Analyze progress

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Physical Fitness

• A condition that helps one look, feel, and do his
  or her best
• Physical fitness is individual
• Varies from person to person

• Influenced by
• Age
• Gender
• Heredity
• Personal habits
• Exercise
• Eating habits

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Benefits of Physical Fitness

• Decrease in resting heart rate and blood pressure
• less work load greater efficiency of body
  function
• Increase in oxygen carrying capacity
• Enhanced quality of life
• Increase in muscle mass
  and metabolism
• Increased resistance to injury
• Improved personal appearance
  and self image
• Maintenance of motor skills throughout
• life

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Cardiovascular Endurance

• Fitness assessment
• Heart rate target zone
• 220 minus your age in years
• and then multiply by 60-80
• example
• 220-25195
• 195 x 0.6 117 beats/minute
• 195 x 0.8 156 beats/minute
• target heart rate is between
• 117 and 156 beats per minute
• during exercise

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Muscular Strength

• Strength endurance assessment
• Principles of training
• Isometric versus isotonic
• isometric - no movement of joint
• isotonic - joint moved through range of motion
• Resistance
• amount of weight moved or
• lifted during isotonics
• Sets - number of times exercise repeated
• Frequency - minimal number of workouts needed for
  positive effect

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Muscular Flexibility

• Flexibility assessment
• Principles of muscular flexibility
• Intensity of exercise
• Repetitions
• Frequency
• Prevention and
  rehabilitation of low back pain

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Being a couch potato can be hazardous to your
health.
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Importance of Sleep

• Sleep deprivation leads to exhaustion
• resistance to all stressors declines
• increased susceptibility to physical
  psychological ailments
• Disruption of circadian timing system
• Circadian (Latin for about a day) rhythm -
  biological cycles that occur about every 24 hours
• Includes hormonal body temp
• changes, appetite sleepiness
• cycles, other body functions

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Disease Prevention

• Regular check ups with your physician is
  essential to maintaining good health

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Cardiovascular Disease

• Components with impact on preventing heart
  disease
• Cardiovascular endurance
• Blood pressure monitoring
• Body composition
• Total cholesterol/ HDL ratio
• Triglyceride levels
• Estrogen use
• Stress responses
• Periodic risk assessment

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Cigarette Smoking

• Health ramifications
• negative effects on cardiovascular system
• increased incidence of lung cancer
• Why people smoke
• Peer pressure
• Relief of stress
• Weight control
• Addictive properties of nicotine
• Smoking cessation resources available

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Cancer

• The term cancer encompasses more than 100
  diseases affecting nearly every part of the body
• All are potentially life-threatening
• Fundamental cause of all cancer is a change or
  mutation in the nucleus of a cell
• Most common cancers are linked to one of three
  environmental risk factors
• Smoking
• Sunlight
• Diet

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Steps in Cancer Prevention

• Eliminating smoking
• Making dietary changes
• Minimizing sun exposure using sun screen
• Regular physical examinations
• Watching for the warning
  signs
• Periodic risk assessment

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Cancer Warning Signs(CAUTION)

• Change in bowel or bladder habits
• A sore throat that does not heal
• Unusual bleeding or discharge
• Thickening or lump in the breast or elsewhere
• Indigestion or difficulty swallowing
• Obvious change in a wart or mole
• Nagging cough or hoarseness
• Source The
  American Cancer Society

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Infectious Disease

• Hygiene - hand washing (20 seconds minimum) most
  effective tool to helping to keep you healthy
• Using engineering and work practice controls
• Reporting exposure promptly and doing follow-up
  recommended
• Periodic risk assessment

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Injury Prevention

• Job-related injuries can be minimized by being
  knowledgeable about
• Body mechanics during lifting and moving
• Being alert for hostile environments
• Prioritizing personal
  safety during rescue situations
• Practicing safe vehicle
  operations
• Using safety equipment
  and supplies

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Body Mechanics During Lifting and Moving

• Only move a victim you can safely handle get
  additional help if needed
• Look where youre walking or crawling
• Move forward rather than backward
  when possible
• Take short steps, if walking
• Bend at hips and knees
• Lift with legs, not back
• Keep load close to the body
• Keep patients body in-line when moving

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Hostile Environments

• Carefully evaluate scene for safety concerns
• Do not enter scene until it is safe
• Coordinate all activities with law enforcement
  personnel
• Follow protocols for establishing
  Medical Incident Command
• Plan an entrance and escape
• route(s)
• Above all else, stay alert
  and be prepared for
  the
• unexpected

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Mental and Emotional Health

• Substance misuse/abuse control
• Anxiety and stress
• Personal time/meditation/
  contemplation
• Family, peer, community
  connections
• Freedom from prejudice

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Warning Signs of Addiction and Addictive Behavior

• Using a substance to relieve tension
• Using an increasing amount of the substance
• Lying about using the substance
• Experiencing guilt about using the substance
• Avoiding discussion about using
  the substance
• Interference with daily
  activities due to substance abuse

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Substance Abuse Management

• Methods used to manage substance abuse depend on
  the type of substance being misused
• Substance misuse/abuse control may include a
  combination of professional counseling,
  physician-controlled medication therapy, and
  support programs

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Anxiety and Stress

• Stress results from the interaction of events
  (environmental stimuli) and the adjustive
  capabilities of the individual
• Usually seen as generating
  negative affect (fear, depression,
  guilt, etc.)
• Stress also experienced
• with positive events

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Anxiety and Stress

• Anxiety
• Uneasiness or dread about future uncertainties
• Eustress
• Good stress
• Response to positive stimuli
• Distress
• Bad stress
• A negative response to an
  environmental stimulus

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Meditation and Contemplation

• Setting aside some personal time for meditation
  and contemplation can greatly enhance mental, and
  perhaps even physical,
  health

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Spirituality

• A unique characteristic of human existence
• Should not be overlooked as an effective means
  for some to achieve mental and physical well-being

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Family, Peer, and Community Connections

• Belonging to groups can affect a persons
  motivation and performance in very positive ways
• People tend to associate with others most like
  themselves (e.g., family members,
  coworkers, members of community
  and religious organizations)
• These groups provide a connection
  with people who share similar values
  and interests

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Freedom From Prejudice

• Acceptance of cultural differences
  allows individuals to
• Learn about other cultures
• See cultural variations in a
  positive light
• Affirm the value of these differences

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Freedom From Prejudice

• Acceptance of individual differences
• Recognize existence of differences
• Listen until you can tell
  the other person's story
• Work toward
  win-win solution

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Stress Management
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Stress

• Stress is a state of physical or psychological
  arousal.
• Hazard of emergency work
• Always present to some degree
• EMS providers must manage stress
• to prevent Burnout
• 3 phases of stress response
• Alarm reaction
• Resistance
• Exhaustion

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3 Phases of Stress Reaction Phase 1 - Alarm
Reaction

• Fight or flight phenomenon
• Considered to be positive takes only seconds to
  become activated
• Prepares individual for action/self-defense
• Mediated by the sympathetic nervous system branch
  of the autonomic nervous system

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Alarm Reaction

• Fight or flight phenomenon
• Physiological response
• Increased heart rate
• Increased blood pressure
• Pupillary dilation
• Excessive perspiration
• Relaxation of bronchial tree
• Increased blood glucose levels
• Slowed digestion
• Sense of anxiety
• Alarm reaction ends when body realizes the event
  is no longer dangerous

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Phase 2 - Resistance

• The individual begins to adapt to the stress
  through the use of defense mechanisms.
• Reaction to stressor may change with time.

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Phase 3 - Exhaustion

• Prolonged exposure to the same stressors leads to
  the exhaustion of an individuals adaptation
  energy. Signs of the alarm reaction reappear,
  and are more difficult to reverse.
• Increased susceptibility to physical
• and psychological ailments
• Rest and recovery
• are needed

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Factors that Trigger the Stress Response

• Examples include Loss of something that is of
  value Injury or threat of injury Poor health
  or nutrition Frustration Ineffective coping
  skills

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Causes of Stress in EMS

• ?Environmental
• Siren noise
• Inclement weather
• Confined work places
• Rapid scene response
• Life and death decision making
• ? Psychosocial
• family relationships
• conflicts with supervisors, co-workers
• abusive patients

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Causes of Stress in EMS

• ? Personality
• Need to be liked
• Personal expectations
• Feelings of guilt and anxiety

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Reactions to Stress

• Vary with individuals
  and affected by
• Previous exposure to the stressor
• Perception of the event
• Experience
• Personal coping skills

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Three Types of Stress Reactions

• Acute Stress Reaction
• a reaction that occurs soon after a catastrophic
  event has powerful impact on person
• Delayed Stress Reaction
• occurs days, weeks, or months after a critical
  incident also called
• post-traumatic stress disorder
• Cumulative Stress Reaction
• continuous exposure to stressors
• burnout

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Delayed Stress Reaction - Post-Traumatic Stress
Disorder

• Effects
• marital problems, alcohol drug abuse,
  personality changes, increased suicide incidence

• Signs and Symptoms
• Re-experiencing the traumatic event
• Diminished responsiveness to the external world
• Interpersonal relationships altered

• Hyper-alertness
• Difficulty sleeping
• Survivor guilt
• Memory impairment
• Avoidance of any activities that may cause recall
  of event
• Avoidance of thoughts or feelings associated with
  the incident

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Physiological and Psychological Effects of Stress

• Anxiousness in certain situations
• or unusual circumstances is
• normal a warning system for self-protection
  preparation for action
• Detrimental reactions to anxiety/stress -a
  continued state of alertness beyond the state of
  the emergency self-preparation for danger has
  not been reduced

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Physical Effects of Anxiety/Stress

• Heart palpitations
• Difficult/rapid breathing
• Chest tightness/pain
• Anorexia
• Flushing, diaphoresis
• Sleep disturbances
• Aching muscles and joints
• Backache, headache

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Emotional Effects of Anxiety/Stress

• Panic reactions
• Fear
• Anger
• Denial
• Feeling overwhelmed

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Cognitive Effects of Anxiety/Stress

• Difficulty making decisions
• Disorientation, decreased level of awareness
• Memory problems, poor
  concentration
• Distressing dreams

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Behavioral Effects of Anxiety/Stress

• Crying spells
• Hyperactivity
• Withdrawal
• Changes in eating
  habits
• Increased smoking
• Increased alcohol consumption
• Drug abuse

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Adaptation to Stress

• Dynamic, evolving process whereby one learns
  successful ways to deal with stressful situations
• This process
• Usually begins with using defense mechanisms
• Coping skills then developed
• Followed by problem solving
• Culminating in mastery

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Defense Mechanisms

• Adaptive function of personality
• Assists in adjusting to stressful situations
• Helps in avoiding dealing with problems
• Defense mechanisms
• repression - involuntary banishment of
  unacceptable ideas or impulses into the
  unconscious
• regression - return to an earlier level of
  emotional adjustment
• projection - attributing to another person those
  thoughts, feelings, motives, or desires which are
  really ones own unacceptable traits

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Defense Mechanisms continued

• rationalization - process of ascribing acceptable
  or worthwhile motives to feelings, thoughts, or
  behavior which really have other unrecognized
  motives
• reaction formation - direction of overt behavior
  or attitudes in precisely the opposite direction
  of the individuals underlying, unacceptable
  impulses
• denial - unconscious disavowal of thoughts,
  feelings, wishes, or needs which are
• consciously unacceptable

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Responding to Stress

• Coping
• active, confronting process
• information gathered/used to change
• or adjust to a new situation
• Problem solving
• healthy approach to everyday concerns
• uses problem analysis, option analysis for
  action, determination of course of action
• Mastery
• ability to see multiple option/potential
  solutions
• results from experience with similar situations

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Stress Management Techniques

• Methods used to initially manage stress include
• Reframing
• Controlled breathing
• Progressive relaxation
• Guided imagery

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Stress Management

• Reframing
• looking at situation from different point of view
• Controlled breathing
• natural stress reliever creates calm
• Progressive relaxation
• tighten/relax particular muscle groups fools
  body into thinking it is relaxing
• Guided imagery
• guided thru stress response by concentrating on
  an image that helps relieve stress

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Other Stress Interventions

• Being aware of personal limitations
• Peer counseling and group discussions
• Proper diet, sleep, and rest
• Pursuit of positive activities outside of EMS to
  balance work and recreation
• Utilizing other intervention programs that may be
  available through EMS agencies, hospitals, and
  other groups

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Critical Incident Stress Management

• CISM is an organized, formal, peer and mental
  health support network and process
• Enables emergency personnel to vent feelings
• Facilitates understanding of stressful responses
• Reassures personnel that what they are
  experiencing is normal and may be common to
  others involved in the incident

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CISM

• Situations in which CISM should be considered
• Line of duty injury or death
• Disaster
• Emergency worker suicide
• Infant/ child death
• Extreme threat to emergency worker
• Prolonged incident regardless if end is loss or
  success
• Victims known to operations personnel
• Death/ injury of civilian caused by operations
• Other significant event

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Components of CISM

• Pre-incident stress training
• On-scene support to distressed personnel
• Individual consults
• Defusing services immediately after a large scale
  incident
• Mobilization services after large scale incident
• Critical incident stress debriefing 24 to 72
  hours after an event
• Follow-up services
• Specialty debriefings to non-emergency groups in
  the community
• Support during routine discussions of an incident
• Advice to command staff during large scale
  incident
• 1-800-225-2473

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Defusing

• Informal gathering of the people involved in the
  event and two-person CISM-trained teams who are
  also peers
• Usually takes place within 8 hours after an event
• Allows initial release of feelings
• Allows opportunity for people to share their
  experiences
• Usually lasts lt one hour

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Debriefing

• More formal than a defusing
• Conducted in a confidential setting
• Usually takes place 24 to72 hours after the event
• Conducted by a specially trained CISM team of
  other emergency services personnel and mental
  health workers
• Only those present at the incident
  are allowed to attend a debriefing

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Reducing Crisis-induced Stress

• Taking care of the care taker
• Appropriate rest breaks
• Replacement of food and fluids
• Limitation of exposure to incident
• Change of assignments
• Providing post-event defusing/ debriefing
• Studies note that most people will recover
  naturally from stressful situation

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Death and Dying

• Elizabeth Kubler-Ross found that most people go
  through 5 stages of grief
• Denial - no, not me
• Anger - why me?
• Bargaining - okay, but first let
• me...
• Depression - yes, me in mourning
• withdraws, retreats
• Acceptance - okay, Im not afraid family may now
  need more support

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Conveying News of a Sudden Death

• Gather family in a private area
• Advise them of patient's death, with a brief
  description of circumstances causing the death
• The words death or dead should be used
• Be compassionate
• Allow family to see their relative if they
  choose prepare family in laymen terms of what
  they may see

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Common Needs of the Paramedic when Dealing with
Death and Dying

• Paramedic may experience some of the stages of
  grief
• Support from friends, coworkers, family
  following incident
• Opportunity to process specific incident and
  obtain closure important
• Use available resources to avoid effects of
  cumulative stress

85
Developmental considerations when dealing with
death and dying

• Newborn to age three
• Children will sense that something has happened
  in the family.
• Children will realize that people are crying and
  are sad all the time.
• Children will realize that
  there is much activity in
  their household.

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Developmental considerations when dealing with
death and dying

• Newborn to age three
• Watch for changes in
• Eating or sleeping patterns
• Irritability
• Suggestions
• Be sensitive to the childs needs
• Try to maintain consistency in routines
• Maintain consistency with significant people in
  the childs life

87
Developmental considerations when dealing with
death and dying

• Three to six years of age
• Child does not have concept of the finality of
  death
• Believes that the person will return and will
  continually ask when the person will return
• Believes in magical thinking (feels responsible
  for the death)
• Child may believe that everyone
• else they love will also die

88
Developmental considerations when dealing with
death and dying

• Three to six years of age
• Watch for changes in
• Behavior patterns with friends and at school
• Difficulty sleeping
• Changes in eating habits
• Suggestions
• Emphasize to the child that he was not
  responsible for the death
• Reinforce that when people are sad they cry
  crying is normal and natural
• Encourage the child to draw pictures of his
  feelings, or talk about his feelings

89
Developmental considerations when dealing with
death and dying

• Six to nine years of age
• Beginning to understand the finality of death
• Will seek out detailed explanations for the death
• Will be afraid other significant people in their
  lives will die as well
• Be uncomfortable in expressing feelings. May act
  silly or embarrassed when talking about death

90
Developmental considerations when dealing with
death and dying

• Six to nine years of age
• Suggestions
• Talk about the normal feelings of anger, sadness
  and guilt
• Share your own feelings about death do not be
  afraid to cry in front of the child- this gives
  the child permission to express their feelings

91
Developmental considerations when dealing with
death and dying

• Nine to twelve years of age
• Aware of the finality of death
• Concerned with practical matters concerning the
  childs lifestyle
• May want to know all the details surrounding the
  death
• May try to act like an adult, but then show
  regression to an earlier stage of emotional
  response

92
Developmental considerations when dealing with
death and dying

• Nine to twelve years of age
• Suggestions
• Set aside time to talk about feelings
• Encourage sharing of memories to
  facilitate grief response

93
Developmental considerations when dealing with
death and dying

• Elderly
• Concerned about other family members
• Concerned about further loss of independence
• Concerned about cost

94
Quotes to Think About...

• Every human being is the author of his own health
  or disease.
• Author Sivananda
• No rain - no rainbow.
• Author unknown

95
Well-Being of the Paramedic

• Material prepared by
• Brian Sobeck, BA, NREMT-P (NIEMSCA)
• Modifications by
• Sharon Hopkins, RN, BSN,EMT-P

• Questions ??